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For psychiatrists, it is a violation to cross the "patient-lover boundary" with any person who has ever been in the other role.According to the American Psychiatric Association: "Sexual activity with a current or former patient is unethical....Sexual or romantic relationships with former patients are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the previous professional relationship." Note that this last statement leaves open the possibility that such relations might not be unethical if the physician doesn't exploit aspects of the former relationship.Also, the AMA is silent here about former lovers becoming current patients. Colorado's Medical Practice Act specifies a six-month "waiting period" after a professional relationship has ceased before a sexual one may begin.You, who are medical directors out there, please consider how you would react to a request for an out-of-network referral based on "personal reasons." The geographic reality doesn't create the ethical bind, but a contractual restriction.I'd counsel any MCO or physician group facing this issue to step out of the way instantly.One could argue that married couples are an exception,but that view requires an understanding of relationships that is absent from the "no overlap" policy.

The inflexible letter of the law weighs unfairly on some defendants, and sometimes compels a disciplinary body to impose sanctions that don't fit a case's nuances.

The subject of physician-patient boundaries illustrates how well-intentioned policy can be written in a way that is simply too shallow to serve the goals of ethics.

If you've sat on a credentials committee, disciplinary panel, or medical-licensing board, you surely reviewed cases of physician-patient sexual involvement.

Suppose our small-town doctor becomes smitten with a local beau or belle.

Let's say both fully understand the potential conflict of interest that arises if the doctor prescribes penicillin for a strep throat.

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